Disposable visceral retainer

ABSTRACT

A collapsible disposable retainer device for insertion beneath an abdominal incision for temporarily retaining viscera inside the abdominal cavity of a patient during closure of an abdominal incision following surgery. The retractor is in the form of a flat oval-shaped piece of transparent flexible plastic or rubber material which has a peripheral tubular bladder inflatable with air or other gas from an inflation device to impart rigidity to the structure during use. Following use the bladder is emptied of gas and the retractor collapsed, permitting its ready withdrawal from a small opening left in the abdominal incision.

United States Patent [1 1 Kleaveland 1 Feb.4, 1975 DISPOSABLE VISCERAL RETAINER [76] Inventor: Richard N. Kleaveland, 426 Medical Center, Spokane, Wash. 99203 [22] Filed: Apr. 4, 1974 [21] Appl. No.: 457,906

[52] U.S. C1 128/303 R, 128/20, 128/132, 128/334 R, 128/344 [51] Int. Cl. A6lb 17/00, A61b 19/00 [58] Field 01 Search 128/20, 132,255, 341, 128/344, 303 R, 334 R [56] References Cited UNITED STATES PATENTS 1,060,350 4/1913 Miller 128/303 R 1,275,520 8/1918 Bell 128/341 1,947,649 2/1934 Kadavy 128/303 R 2,663,020 12/1953 Cushman 128/132 R 3,626,949 12/1971 Shute 128/344 OTHER PUBLlCATlONS Comprehensive Guide to Purchasing, V. Mueller &

Co., 1956, page 829, ltems SU-lSSOO-ISBO'I.

Primary ExaminerAldrich F. Medbery Attorney, Agent, or FirmChernoff & Vilhauer {57] ABSTRACT A collapsible disposable retainer device for insertion beneath an abdominal incision for temporarily retaining viscera inside the abdominal cavity of a patient during closure of an abdominal incision following surgery. The retractor is in the form of a flat ovahshaped piece of transparent flexible plastic or rubber material which has a peripheral tubular bladder inflatable with air or other gas from an inflation device to impart rigidity to the structure during use. Following use the bladder is emptied of gas and the retractor collapsed, permitting its ready withdrawal from a small opening left in the abdominal incision.

22 Claims, 4 Drawing Figures PATENTED 41975 SHEEI 10F 2 FIG.

FIG.4

PATENTEU FEB 4I975 SHEU 2 OF 2 FIG. 2

FIG. 3

1 DISPOSABLE VISCERAL RETAINER BACKGROUND OF THE lNVENTlON This invention relates to a collapsible disposable shield or retainer, sometimes known as a retractor device for insertion beneath an abdominal incision for temporarily retaining viscera inside the abdominal cavity of a patient during suturing of an abdominal incision following surgery.

IN the closure of an abdominal incision of a patient following surgery, the intestines of the patient tend to protrude up through the incision. thereby interfering with the suturing operations of the surgeon and there is a danger that the suturing needle may lacerate or puncture viscera. Thus, it would be advantageous to provide a retainer device which would both temporarily retain the intestines and other viscera while the abdominal incision is being closed and protect them from damage during suture.

Heretofore a reusable piece of thick, flexible material, typically an oblong piece of latex rubber approximately 8 inches long, 4 inches wide and l/l6th of an inch in thickness with a center reinforcing piece, referred to as a fish in the surgical profession, has been placed between the abdominal incision and viscera during suture to minimize the aforementioned problems. However, the prior art fish" device is not large enough to utilize in some incisions and its edges are flexible and floppy, allowing the intestines to find a way, between the material and the pertioneal surface, to protrude into the incision. Furthermore, if a large piece of rubher were used it would necessarily have so much mass that upon being withdrawn near completion of the suture, a large opening would necessarily remain through which bowel could protrude thus hampering prompt and effective closing of the incision.

SUMMARY OF THE PRESENT INVENTION In order to overcome the aforementioned difficulties in the closing of an abdominal incision, the present invention utilizes a sheet of strong, light, filexible, transparent material of appropriate size and shape, depending upon the dimensions of the incision, having an inflatable peripheral tubular bladder. Air or other gas for inflating the bladder portion is introduced and expelled through a non-collapsible vented tube disposed within the peripheral bladder which connects at one end of the retractor to a pump or other device for injecting gas into the bladder portion. The retractor piece also has a thin flap formed entirely around its perimeter which may be used to retain it in place during suture, if necessary or desired, by temporarily tack-stitching the flap to the peritoneal surface of the abdomen with a fine absorbable suture.

Once the retractor is placed inside the abdoment, its bladder portion is inflated by forcing gas, typically air, into it through the vented tube disposed therein, thus imparting sufficient rigidity to the retractor to blockingly retain any intestines which might otherwise tend to protrude through the incision. At the same time the retractor, being made of a flexible material, is not easily expelled from the abdomen by movements of the patient. The viscera are protected from damage by the suturing needle because the inflated peripheral bladder holds the closure in such a position that there is a sizeable clearance space created between the incision closure and the intestine material pressed beneath the center of the retractor, and the thickness of the retractor material itself acts as a shield against accidental punc ture of the intestines by the needles used for suture. in addition, the retractor entirely closes the incision opening, thereby preventing heat from escaping, and. since the retractor is oftransparent material. the surgeon can easily view the viscera during closure of the abdominal opening to determine if there is any bleeding.

With the retractor in place the incision is sewn up. leaving an opening of approximately one-half inch diameter at the point where the exterior portion of the air tube connects to the bladder of the retractor. The retractor is then collapsed to reduce its mass to a very small size by exhausting the gas therefrom and. being of flexible material, it can then readily be pulled out through the small remaining opening by utilizing the tube as a means of withdrawal. The entire retractor may then be discarded since it is readily and economically fabricated in high volume production from inexpensive plastic material.

lt is therefore a principal objective of this invention to provide a novel and improved abdominal contents retractor for temporarily retaining the viscera of a patient during suture of an abdominal incision following surgery.

It is another principal objective of this invention to provide an abdominal retractor of the type described which is collapsible to a small mass for permitting its ready removal through a small opening in the incision.

It is a principal feature of this present invention to provide a novel abdominal contents retractor of inexpensive manufacture which may be economically dis posed of following a single use.

It is another feature of this invention to provide an inflatable and collapsible bladder-like abdominal retractor of the type described which integrally incorporates means for inflating and deflating the bladder portion thereof.

It is yet another feature of this invention to provide an inflatable bladder-like abdominal retractor of the type described having a peripheral sewing flap for its temporary retention in place by tack-stitching of the retractor to the peritioneal surface of the abdomen.

It is a principal advantage of the retractor of the present invention that the intestines of a patient are prevented from moving around the edges of the retractor and protruding into the abdominal incision.

It is another principal advantage of the retractor of this invention that the patients viscera are protected from damage by the suturing needle.

It is still another principal advantage of the present invention that the retractor, being made of transparent material, enables the surgeon to view the patients viscera, while closing the incision, for detection of bleeding.

And it is yet another advantage of this invention to provide a retractor which will completely isolate an abdominal incision from the viscera in order to facilitate suturing and prevent heat loss from within the patients abdomen.

The foregoing and other objectives. features, and advantages of the invention will be more readily under stood upon consideration of the following detailed description of the invention, taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. I is a top view of an embodiment of an abdominal retractor in accordance with the present invention.

FIG. 2 is a top view of the abdominal retractor positioned in the abdomen of a patient.

FIG. 3 is a sectional view taken along lines 2-2 of FIG. 2.

FIG. 4 is a side view of the retractor in the process of removal from the abdomen of a patient.

DESCRIPTION OF THE PREFERRED EMBODIMENT Referring to FIG. I, the abdominal contents retractor or retainer is an oblong, generally oval-shaped flat and thin piece of strong flexible material such as plastic film having a continuous tubular gas-inflatable bladder 12 formed in the material near its perimeter. A relatively small-diameter gas tube, of a non-collapsible, flexible material such as polyethylene (eg, Bardic l7ll Levin-type stomach tube), is connected to the bladder at one end of the retractor and has an interior portion I4 with spaced vents I6 disposed within the bladder 12, and an exterior portion 18 without vents which provides a path for entry and exit of gas to and from the bladder. The tube portion 14 with the spaced vents [6 provides a non-collapsible conduit. therby permitting gas in all parts of the bladder to readily escape when the bladder is deflated. This arrangement thus prevents trapped air pockets from forming during deflation which would otherwise render the retractor too large to be conveniently removed through a small, approximately one-half inch diameter opening in the incision. In addition, a plurality of stiffener ribs (not shown) may also be provided, if desired, in the center of the retractor to furnish additional rigidity to the center of the retractor. These ribs should fan out radially from the end 15 to which the exterior portion 18 ofthe gas tube connects so that they do not hinder removal ofthe retractor from the small opening left in the incision. The ribs may be bladder-like, similar and connnected to the peripheral bladder, or, in order to avoid accidental puncture during suturing, they may be made ofa solid flexible material such as nylon strips,

The exterior portion of the gas tube 18 connects to an operating apparatus such as an aspirator syringe bulb 22 (e.g., Travenol Medaseptic MP syringe. 2 oz. neonatal size, code no 202 I94) with an associated control and venting valve 24 for forcing gas, typically air, into the bladders of the retractor and releasing it therefrom. Alternately a gas cartridge or piston-type syringe could be utilized instead ofthe bulb-type syringe 22 as the means for inflating the retractor. The inflation and venting devices may be an integral part ofthe retractor so that the entire unit can undergo sterilization prior to use by a method such as gas autoclavation. or it may also be feasible, for example, to have the pressurizing device 22 and control valve 24 reusable, with the rest of the retractor disposable after a single use.

The retractor may be fabricated, for example, by stamping two similar oval-shaped pieces out of polyethylene, vinyl, rubber (e.g., Latex as used for disposable rubber gloves), or other appropriate material, and then gluing or heat-sealing them together in a pattern which defines the tubular bladder portion. If adhesive polyethylene such as Steri-Drape No. I050 (3M Company) is used, the oval bladder shape may be formed separately as a tubular body from non-adhesive polyethylene material and then sandwiched between two larger adhesive sheets to form the inflatable chamber. The vented portion ofthe gas tube 14 is most easily installed by placing it between the two pieces of material forming the bladder prior to sealing the sandwich-like combination. the gas tube extending through an opening in the material at one end 15 ofthe retractor and connecting to either the inside edge, as shown, or the outside edge of the bladder.

In practice, an appropriate retractor 10 should be chose from among a group of standard sizes and shapes, depending upon the size and shape of the patient's incision, and, as shown in FIGS. 2 and 3. temporarily placed in the patient's abdomen 25 between the incision 26 and the viscera 28, a typical incision for abdominal surgery extending from the xyphoid 30 to the pubis 32. The retractor is placed so that the end I5 to which the exterior portion I8 of the gas tube connects is at the end of the incision which will be closed last, the tube extending through the last portion of the incision to be closed.

In order to insure that the retractor remains in place during sutura, a sewing flange 34 is provided around the periphery of the retractor for tack-stitching it to the pertioneal surface of the abdomen if deemed necessary. Once the retractor is in place, gas is forced into the bladder to inflate it and suture of the incision may proceed. The retractor may also be used in a similar manner to temporarily seal off the chest cavity during lung surgery in order to permit inflation of a lung.

When the retractor I0 is installed, the edges 36 of the incision overlap it, sealing offthe viscera. This prevents the intestines 38 from moving over the edges of the retractor and protruding into the incision, and also reduces heat loss from the patients body. By making the retractor wholly or partially from transparent material a window 40 is centrally provided therein, as shown in FIGS. 1 and 2, permitting viewing ofthe internal organs to determine if there is any bleeding. The gas-filled bladder ofthe retractor is protected from puncture because suturing takes place over the center of the retractor where there is no inflated bladder portion, and the space between the incision edges and the retractor surface, as well as the retractor material itself, protect the viscera from puncture by the suturing needle. As a convenience in abdominal surgery where, as shown in FIG. 2, the top edge of the retractor is inserted underneath the sternum, the end of the exterior tube 18 connecting to the bladder is configured to fold down and lie against the face of the retractor.

Suture is accomplished by sewing the incision togetber, leaving an opening 42 approximately inch in length adjacent the end 15 to which the exterior portion of the tubing I8 is connected, as shown in FIG. 4. The gas in the bladder is then released through opening of the vent valve 24, deflating the retractor and reducing its mass, The retractor 10 is next withdrawn from the abdomen initially using the tubing 18 to pull it out through the small opening 42 which is subsequently closed with little or no interference from intestines. The retractor may then simply be discarded.

The terms and expressions which have been employed in the foregoing abstract and specification are used therein as terms of description and not of limitation, and there is no intention in the use of such terms and expressions of excluding equivalents ofthe features shown and described or portions thereof, it being recognized that the scope of the invention is defined and limited only by the claims which follow:

What is Claimed is:

l. A collapsible retainer including means for temporarily retaining the body contents inside a patient during the suture of an incision following surgery. comprismg:

a. a biologically sterile sheet of flexible. crushable material configured to fit within and beneath said incision;

b. an inflatable rib-like bladder formed in said sheet:

c. inflation means connected to said bladder for forcing gas into said bladder to render said sheet substantially flat and rigid; and

d. exhusting means connected to said bladder for releasing said gas therefrom to collapse said sheet.

2. The retainer of claim 1 wherein said inflatable bladder is tubular in shape.

3. The retainer of claim I wherein at least a portion of said inflatable bladder is formed in said sheet near a peripheral portion thereof.

4. The retainer of claim 3 adapted for abdominal surgery wherein said sheet includes a narrow flange portion formed along the periphery thereof for providing a flap-like surface adapted for tack-stitching said retractor to the peritoneal surface of the patients abdomen.

5. The retainer of claim 1 wherein the shape of said sheet is substantially oval.

6. The retainer of claim 1 wherein said sheet material is transparent.

7. The retainer of claim 1 wherein said sheet is of a material sterilizable by gas autoclaving.

8. The retainer of claim 1 wherein said inflation means comprises a tube connected to sand bladder and injecting means for forcing gas into said bladder through said tube.

9. The retainer of claim 1 wherein said exhausting means comprises a tube connected to said bladder and valve means associated with said tube for controllably releasing gas from said bladder through said tube.

10. The retainer of claim 9 wherein said tube portion of said exhausting means is non-collapsible and comprises a first segment having a plurality of spaced vents disposed interior to said bladder and a non-vented second segment disposed exterior to said bladder, and said valve means is connected to said second segment at the end thereof which is opposite the connection of said tube with said bladder.

11. The retainer ofclaim 10 wherein said vale means is a bidirectional control valve and said inflation means comprises said tube. said valve means, and a pressurizer means disposed at the end of said tube opposite its connection with said bladder for increasing the pressure of said gas interior thereto.

12. The retainer of claim 11 wherein said bidirectional control valve comprises a stopcock.

l3. The retainer of claim ll wherein said bidirectional control includes a flutter-valve.

14. The retainer of claim 11 wherein said pressurizer means comprises a piston syringe.

15. The retainer of claim It wherein said pressurizer means comprises a bulb syringe.

16. The retainer of claim I wherein all of the components forming said retractor are comprised of materials sterilizable by gas autoclaving.

17. The retainer of claim 1 wherein said inflation means and said exhausting means are detachably connected to said bladder.

18. A collapsible visceral retainer. including means for temporarily retaining the visceral contents inside the abdominal cavity of a patient durint the suture of an abdominal incision following surgery. comprising:

a. a biologically sterile sheet of flexible. crushable material configured to fit within and beneath said abdominal incision;

b. an inflatable tubularshaped bladder rib formed in said sheet near a peripheral portion thereof.

c. inflation means connected to said bladder rib for forcing gas into said bladder rib to render said sheet substantially flat and rigid; and

d. exhausting means connected to said bladder rib for releasing said gas therefrom to collapse said sheet.

19. The retainer of claim 18 wherein said tubular bladder rib is arranged to extend along substantially the entire length of said sheet adjacent the periphery thereof.

20. A collapsible visceral retainer. including means for temporarily retaining the visceral contents inside the abdominal cavity of a patient during the suture of an abdominal incision following surgery. comprising:

a. a biologically sterile sheet of flexible. crushable material configured to fit within and beneath said abdominal incision;

b. an inflatable bladder rib formed in said sheet; and

c. inflation means connected to said bladder rib for forcing gas into said bladder rib to render said sheet substantially flat and rigid and for releasing said gas therefrom to collapse said sheet.

2l. A method for using a visceral retainer of the type comprised of a sheet of flexible. collapsible material having an inflatable bladder formed therein. for temporarily retaining the visceral contents inside the abdominal cavity of a patient during the suture of an abdominal incision following surgery. comprising:

a. placing said retainer while in a collapsed state in the patients abdomen between the incision and the viscera so that the edges of the incision overlap said retainer;

b. inflating said retainer by forcing gas into said bladder to cause said sheet to lie substantially flat and rigid;

c. partially suturing the incision by closing it over substantially the entire length thereof but leaving a small opening therein;

d. collapsing said retainer by deflating said bladder subsequent to said partial suture of the incision; and

e. removing said retainer from the patients abdomen through said opening.

22. The method of claim 21 further characterized in that said retainer includes a gas conducting tube connected to said inflatable bladder and having a segment extending exterior thereto. and wherein said step (a) of placing said retainer while in the collapsed state within the patients abdomen includes disposing said exterior tube segment through the incision so as to protrude outside the patients body and said step (e) of removing said collapsed retainer from the patients abdomen through said opening is initiated by pulling on said 

1. A collapsible retainer including means for temporarily retaining the body contents inside a patient during the suture of an incision following surgery, comprising: a. a biologically sterile sheet of flexible, crushable material configured to fit within and beneath said incision; b. an inflatable rib-like bladder formed in said sheet; c. inflation means connected to said bladder for forcing gas into said bladder to render said sheet substantially flat and rigid; and d. exhusting means connected to said bladder for releasing said gas therefrom to collapse said sheet.
 2. The retainer of claim 1 wherein said inflatable bladder is tubular in shape.
 3. The retainer of claim 1 wherein at least a portion of said inflatable bladder is formed in said sheet near a peripheral portion thereof.
 4. The retainer of claim 3 adapted for abdominal surgery wherein said Sheet includes a narrow flange portion formed along the periphery thereof for providing a flap-like surface adapted for tack-stitching said retractor to the peritoneal surface of the patient''s abdomen.
 5. The retainer of claim 1 wherein the shape of said sheet is substantially oval.
 6. The retainer of claim 1 wherein said sheet material is transparent.
 7. The retainer of claim 1 wherein said sheet is of a material sterilizable by gas autoclaving.
 8. The retainer of claim 1 wherein said inflation means comprises a tube connected to sand bladder and injecting means for forcing gas into said bladder through said tube.
 9. The retainer of claim 1 wherein said exhausting means comprises a tube connected to said bladder and valve means associated with said tube for controllably releasing gas from said bladder through said tube.
 10. The retainer of claim 9 wherein said tube portion of said exhausting means is non-collapsible and comprises a first segment having a plurality of spaced vents disposed interior to said bladder and a non-vented second segment disposed exterior to said bladder, and said valve means is connected to said second segment at the end thereof which is opposite the connection of said tube with said bladder.
 11. The retainer of claim 10 wherein said vale means is a bidirectional control valve and said inflation means comprises said tube, said valve means, and a pressurizer means disposed at the end of said tube opposite its connection with said bladder for increasing the pressure of said gas interior thereto.
 12. The retainer of claim 11 wherein said bidirectional control valve comprises a stopcock.
 13. The retainer of claim 11 wherein said bidirectional control includes a flutter-valve.
 14. The retainer of claim 11 wherein said pressurizer means comprises a piston syringe.
 15. The retainer of claim 11 wherein said pressurizer means comprises a bulb syringe.
 16. The retainer of claim 1 wherein all of the components forming said retractor are comprised of materials sterilizable by gas autoclaving.
 17. The retainer of claim 1 wherein said inflation means and said exhausting means are detachably connected to said bladder.
 18. A collapsible visceral retainer, including means for temporarily retaining the visceral contents inside the abdominal cavity of a patient durint the suture of an abdominal incision following surgery, comprising: a. a biologically sterile sheet of flexible, crushable material configured to fit within and beneath said abdominal incision; b. an inflatable tubular-shaped bladder rib formed in said sheet near a peripheral portion thereof; c. inflation means connected to said bladder rib for forcing gas into said bladder rib to render said sheet substantially flat and rigid; and d. exhausting means connected to said bladder rib for releasing said gas therefrom to collapse said sheet.
 19. The retainer of claim 18 wherein said tubular bladder rib is arranged to extend along substantially the entire length of said sheet adjacent the periphery thereof.
 20. A collapsible visceral retainer, including means for temporarily retaining the visceral contents inside the abdominal cavity of a patient during the suture of an abdominal incision following surgery, comprising: a. a biologically sterile sheet of flexible, crushable material configured to fit within and beneath said abdominal incision; b. an inflatable bladder rib formed in said sheet; and c. inflation means connected to said bladder rib for forcing gas into said bladder rib to render said sheet substantially flat and rigid and for releasing said gas therefrom to collapse said sheet.
 21. A method for using a visceral retainer of the type comprised of a sheet of flexible, collapsible material having an inflatable bladder formed therein, for temporarily retaining the visceral contents inside the abdominal cavity of a patient during the suture of an abdominal incision following surgery, comprising: a. placing said retainer while in a collapsed state in the patient''s abdomen between the incision and the viscera so that the edges of the incision overlap said retainer; b. inflating said retainer by forcing gas into said bladder to cause said sheet to lie substantially flat and rigid; c. partially suturing the incision by closing it over substantially the entire length thereof but leaving a small opening therein; d. collapsing said retainer by deflating said bladder subsequent to said partial suture of the incision; and e. removing said retainer from the patient''s abdomen through said opening.
 22. The method of claim 21 further characterized in that said retainer includes a gas conducting tube connected to said inflatable bladder and having a segment extending exterior thereto, and wherein said step (a) of placing said retainer while in the collapsed state within the patient''s abdomen includes disposing said exterior tube segment through the incision so as to protrude outside the patient''s body and said step (e) of removing said collapsed retainer from the patient''s abdomen through said opening is initiated by pulling on said tube. 